Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994-2013

Access to health care for asylum-seekers and refugees (AS&R) in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a) restricted access; and (b) two major policy reforms (1997, 2007) on inci...

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Bibliographic Details
Published in:PloS one 2015-07, Vol.10 (7), p.e0131483-e0131483
Main Authors: Bozorgmehr, Kayvan, Razum, Oliver
Format: Article
Language:English
Subjects:
Age differences
Aggregate data
Analysis
Cost analysis
Data quality
Databases, Factual
Displaced persons
Emigrants and Immigrants
Epidemics
Epidemiology
Expenditures
Exposure
Female
Germany
Health care
Health care access
Health care costs
Health care expenditures
Health care policy
Health care services accessibility
Health services
Health Services Accessibility
Humans
Immunization
Male
Migration
Policy reform
Political asylum
Population policy
Public health
Quasi-experimental methods
Reforms
Refugees
Regression analysis
Regression models
Retrospective Studies
Secularism
Statistics
Systematic review
Vaccines
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Summary:Access to health care for asylum-seekers and refugees (AS&R) in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a) restricted access; and (b) two major policy reforms (1997, 2007) on incident health expenditures for AS&R in 1994-2013. We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013) to compare incident health expenditures among AS&R with restricted access (exposed) to AS&R with regular access (unexposed). We calculated incidence rate differences (∆IRt) and rate ratios (IRRt), as well as attributable fractions among the exposed (AFe) and the total population (AFp). The effects of between-group differences in need, and of policy reforms, on differences in per capita expenditures were assessed in (segmented) linear regression models. The exposed and unexposed groups comprised 4.16 and 1.53 million person-years. Per capita expenditures (1994-2013) were higher in the group with restricted access in absolute (∆IRt = 375.80 Euros [375.77; 375.89]) and relative terms (IRR = 1.39). The AFe was 28.07% and the AFp 22.21%. Between-group differences in mean age and in the type of accommodation were the main independent predictors of between-group expenditure differences. Need variables explained 50-75% of the variation in between-group differences over time. The 1997 policy reform significantly increased ∆IRt adjusted for secular trends and between-group differences in age (by 600.0 Euros [212.6; 986.2]) and sex (by 867.0 Euros [390.9; 1342.5]). The 2007 policy reform had no such effect. The cost of excluding AS&R from health care appears ultimately higher than granting regular access to care. Excess expenditures attributable to the restriction were substantial and could not be completely explained by differences in need. An evidence-informed discourse on access to health care for AS&R in Germany is needed; it urgently requires high-quality, individual-level data.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0131483